Beyond the Medical Record

Studies before and since the 1999 Institute of Medicine report have noted the limitations of using medical record reporting for reliably quantifying and understanding medical error. Quantitative macro analyses of large datasets should be supplemented by small-scale qualitative studies to provide insight into micro-level daily events in clinical and hospital practice that contribute to errors and adverse events and how they are reported. Design : The study design involved semistructured face-to-face interviews with residents about the medical errors in which they recently had been involved and included questions regarding how those errors were acknowledged. Objective : This paper reports the ways in which medical error is or is not reported and residents' responses to a perceived medical error. Participants : Twenty-six residents were randomly sampled from a total population of 85 residents working in a 600-bed teaching hospital. Measurements : Outcome measures were based on analysis of cases residents described. Using Ethnograph and traditional methods of content analysis, cases were categorized as Documented, Discussed, and Uncertain. Results : Of 73 cases, 30 (41.1%) were formally acknowledged and Documented in the medical record; 24 (32.9%) were addressed through Discussions but not documented; 19 cases (26%) cases were classified as Uncertain. Twelve cases involved medication errors, which were acknowledged in different categories. Conclusions : The supervisory discussion, the informal discussion, and near-miss contain important information for improving clinical care. Our study also shows the need to improve residents' education to prepare them to recognize and address medical errors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72013/1/j.1525-1497.2005.0098.x.pd

Identification of Dimethyldioctadecylammonium Ion (m/z 550.6) and Related Species (m/z 522.6, 494.6) as a Source of Contamination in Mass Spectrometry

Chemical contamination can be one of the more common problems encountered when performing trace-level analysis regardless of the analytical technique. Minimizing or eliminating background interferences can be a difficult task, so knowledge of the chemical composition of these contaminants can prove invaluable when it comes to identifying the source. Once the source is identified, proper steps may be taken to reduce or eliminate it. In this study, we report the identity of some commonly seen contaminants (m/z 550.6, 522.6, and 494.6) in electrospray ionization (ESI) mass spectrometry (MS). Through MS, tandem MS, accurate-mass, and high-resolution measurements we have identified these background contaminants as being quaternary ammonium species that contain long-chain hydrocarbon groups, where m/z 550.6 is a dimethyldioctadecylammonium ion (C18, C18) and m/z 522.6 and 494.6 are similar in nature but have shorter alkyl-chain groups. The lipophilic nature of these compounds and the fact that they have molecular weights similar to lysophospholipids make them a frequent contaminant in lipidomic studies. The likely sources of these compounds are commonly used personal and household products

XMM-Newton observations of the supernova remnant IC443: I. soft X-ray emission from shocked interstellar medium

The shocked interstellar medium around IC443 produces strong X-ray emission in the soft energy band (E<1.5 keV). We present an analysis of such emission as observed with the EPIC MOS cameras on board the XMM-Newotn observatory, with the purpose to find clear signatures of the interactions with the interstellar medium (ISM) in the X-ray band, which may complement results obtained in other wavelenghts. We found that the giant molecular cloud mapped in CO emission is located in the foreground and gives an evident signature in the absorption of X-rays. This cloud may have a torus shape and the part of torus interacting with the IC443 shock gives rise to 2MASS-K emission in the southeast. The measured density of emitting X-ray shocked plasma increases toward the northeastern limb, where the remnant is interacting with an atomic cloud. We found an excellent correlation between emission in the 0.3-0.5 keV band and bright optical/radio filament on large spatial scales. The partial shell structure seen in this band therefore traces the encounter with the atomic cloud.Comment: 10 pages, 10 figures, accepted for publication in ApJ (20 September 2006, v649). For hi-res figures, see http://www.astropa.unipa.it/Library/OAPA_preprints/ic443ele1.ps.g

Addressing Childhood Obesity in Georgia: Past, Present, and Future

Background: The Trust for America\u27s Health ranks Georgia 17th (16.5%) in the nation for childhood obesity prevalence among youth aged 10-17 years. Georgia has a long history of addressing childhood obesity at the state, regional, and local levels. This report outlines the historical efforts in childhood obesity in Georgia from the mid-1990’s to the present, summarizes current childhood obesity prevention and management strategies, and provides childhood obesity-related data relevant to the current strategies. Methods: Childhood obesity-related efforts in Georgia from 1996 to the present are documented, along with how these efforts led to the creation of Georgia Shape. The Georgia Shape Childhood Obesity Prevention Initiative, created by Governor Nathan Deal in 2012, established a statewide, 10-year plan of action to address childhood obesity. It convenes more than 125 governmental, philanthropic, academic and business community partners quarterly to work towards reducing the incidence of childhood obesity and overweight in Georgia. Evidence supporting the Georgia Shape objectives is described, along with current program and policy efforts that may allow achievement of its goal of having 69% of Georgia’s children in a healthy weight range by the year 2023. Results: Georgia\u27s obesity rate for low-income, 2- to 4-year old children has decreased. Over the 2013-2015 school years, there has been no increase in BMI at the population level among school age children and youth, and the percentage of boys and girls with increased aerobic capacity has improved. Future efforts should focus on middle and high school students; engaging and educating parents of young children; and state policies that support safe, daily physical activity and access to healthy, local food. Conclusions: A long history of childhood obesity activities in Georgia has led to a strategic plan of action, with contributions from many stakeholders. These efforts aim to reduce the prevalence of childhood overweight and obesity in Georgia over 10 years